If you think of Will Self’s demanding novel, Umbrella, as one fell swoop, you get a sense of the simultaneity of the story: stream-of-consciousness, for certain, looping in and out of several characters’ perspectives, though mostly in the third person; overlapping times (after World War II, then in 1971, and finally more-or-less today); with shifting locales (often London) and plenty of leitmotifs that link character and place and occupation or circumstance to one another. Beginning with a quotation from James Joyce—A brother is as easily forgotten as an umbrella—with umbrellas popping up everywhere, but especially in an umbrella shop (where they are made and sold), and likened to the penis with the foreskin pealed back, plus numerous issues of class, though a major portion of the narrative is the goings on of a mental hospital, where numerous patients have been incarcerated for decades—the consequences of encephalitis lethargica, that is, closing down these victims (“post-encephalitics”) to any outer communication, which means catatonic at times and/or with endless repetitive movements, or tics, that are meaningless to the doctors, though links to the patients’ earlier lives before the dreadful influenza scourge of 1917 severed their communication with anyone else…. Audrey Death, the oldest patient in the institution (Friern) is eighty-one years old, tranquilized, which means pumped full of medications like all the other patients, chloreography, frequently resulting in “involuntary movement: tardive dyskinesia that deforms the inmates’ bodies, flapping hands, twitching facial muscles, jerking heads….” Enter Dr. Zachary Busner, younger than the head of the institution and still given to idealism, the possibility of breakthrough with patients who have, in fact, been subject to one form of experimental psychiatry for fifty years, guinea pigs (all of them). Checking the disarray of Audrey’s records, the good doctor discovers: “De’Ath, Audrey, Admitted 26th September 1922, Born Fulham, 1890 (age 32), Spinst. 5’2”, 7st 8lbs,” and given, in 1930, an “authoritative diagnosis of schizophrenia. It would have been impossible to have tracked this pseudonymous patient down through the decades within an institution that remained in a continuing identity crisis, were it not that Miss De’Ath, AKA Miss Death, AKA Miss Deeth, AKA Miss Deerth, remained in exactly the same place, a moth—not dead but hibernating and growing more and more desiccated with the years….” A damning statement about institutionalizing the incommunicative, a damning statement about government wards and their treatment at the whim of mostly disinterested medical practitioners, a damning statement about family. Has Miss Death no siblings? No relatives? No one who has tried to communicate with her for fifty years? Does no one care? Busner does, even filming Audrey’s repetitive movements, slowing them down, and interpreting them as work on an assembly line—during the war as it turns out—then, in part because of his awareness of R. D. Laing, hoping that L-Dopa might make a change in his enkies, which in spite of the resistance of his overseer alters six patients’ lives, AWAKENING them (as Jeffrey Sacs also discovered), opening their memories, unlocking their voices and obviously their thoughts, providing the doctor with a window of insights into the past of his favorite patient (Audrey Death), her life and the lives of her brothers during the war—in short her true identity. How incredibly lucid, how normal she becomes, with occasional remarks from Audrey herself: “If you wish to form some idea of the constitution of my mind, it may well aid you to think of me as a sort of soldier but recently returned from the Front, and afflicted with a very peculiar case of shell shock.” Of course, PTSS, but not any longer. All at once, his favorite patients are human, curious, loquacious like everyone else. Why not take them on an outing or two? Back into the world outside the institution where they have not ventured in five decades. Even trying to get Miss Death communicating with her one surviving brother—a savant—as it now appears that Audrey herself is, all because of the miracle of L-DOPA. Except, as you probably already know, good reader, the results of the drug are only temporary, provoking a reaction within Dr. Busner, so damaging that for the next forty years he himself is maimed—not exactly as Audrey was—but so crippled that his own life becomes one of failure, as he believes he failed with his enkies. And, Will Self, ultimately responsible for presenting all of this? Well, Self wants you to work hard to enjoy Umbrella, which you will by the story’s revealing ending, worked hard enough to keep your mind much more active than his characters were fortunate enough to experience. Some kind of tour de force. Or, just forced?